Wednesday, December 16, 2009

Walgreens. Facing A POWER Shortage?

I can be a little late to things sometimes.

It seems that while I've been busy writing about things like how some customers like to put Rogaine on their penis (please do not put Rogaine on your penis) the biggest player in the retail pharmacy business has been testing the waters with a program that will fundamentally, completely, and forever change the concept of what a drugstore is. Walgreen's calls it their POWER program, and it's been underway for well over a year and a half now in test markets in Florida and Arizona. I blame The Angriest Pharmacist for the fact I'm just getting hip to things. He wrote about it back in May, and if his posts weren't so incredibly boring to try and slog through maybe I would be in the habit of looking at his blog every once in awhile and would have learned about this thing back then.

I kid. You know I love you Angriest. Even though no one would know who you are had you not named yourself after someone else's blog.

Anyway, the POWER program. Before I get into it let me just warn you that everything I know about it I got from digging through miscellaneous blogs and internet forums. Not the most reliable source of information, so don't take anything here as gospel truth, and by all means feel free to send in corrections, but from what I gather the gist of it is to move as much of the prescription filling process off site as possible. This involves large, central fill pharmacies that receive scanned prescriptions and refill orders from several stores, input the data & then either fill them to be delivered back to stores the next day or zap the labels back to the store to be filled by technicians there. Phone calls do not go to your local store, but to a remote call center. That's right. Call your local Walgreen's and you could be talking to someone in a cubicle hundreds of miles away. Drug Utilization Review, (interaction/allergy checking type stuff for those of you not familiar with the lingo) is done at the central fill pharmacy or by a pharmacist working at home. Prior authorizations and insurance rejects are taken care of at the distant central pharmacy cubicles. At the store level, the pharmacist is kept away from the prescription filling process, stationed at the cash register where they are supposed to see the prescription for the first time only when a customer comes to pick it up.

Why would Walgreen's do this? Because a warehouse full of cubicle rats can type in ten thousand sets of prescription data and fill them more quickly, and more importantly, more cheaply, than a dozen sets of pharmacy staff  in various locations around town.

Will it work? That depends on what exactly the force is that lines up against it. Remember that a corporation's primary interest is not just to make money, it is to make more money than last year. If you make $10 billion this year and make only $10 billion the next year, you are a failure in the corporate world. Couple this with the $1.50 (and dropping) prescription insurance dispensing fee, and you can start to make out the handwriting on the wall. Ever since the dawn of capitalism, anyone or anything that has gotten in the way of the corporation and its need to make an extra nickel per share in the next fiscal year has been ruthlessly and mercilessly crushed. So even though it seems to be almost the unanimous opinion of the internet chatterers that these POWER prescriptions are not being filled as accurately as before, that will not stop POWER. Walgreen's, and any other corporation, will pick quicker and cheaper over accurate every time.

By the way, did I mention the part about the massive layoffs of pharmacy technicians and pharmacists? If I know my corporation, the fact that individual store workload might go down 30% will be used as an excuse to reduce staff by 40%, and sure enough, the forums are full of tales of severance packages, voluntary and otherwise, re-interviewing for your old job, and people not making the cut and being let go. Mercilessly crushed he said.

So are we doomed? Not necessarily. Because unlike every other seismic event that has shaken the pharmacy world, there seems to be absolutely nothing in this for the customer other than a pain in the ass. They won't be talking to a person at the store they think they are calling. Pain in the ass. They will be encouraged not to have the audacity to ask for refills the same day they would like to pick them up. This in a business climate where you can have a pair of eyeglasses made in an hour. Pain in the ass. Common insurance rejects, like the 90 day prescription that needs to be billed for a 30 days supply, that take 10 seconds to take care of at store level will now be put in a queue to be dealt with when a cubicle rat gets around to it. Pain in the ass. Now customers will take a certain amount of pain in their asses in return for something, like a lower price, but their tolerance for ass pain is likely to be low when they can have their prescription filled for the exact same copay someplace that isn't asking them to make an appointment to buy 10 Viagra pills.

There is already evidence Walgreen's is finding this out. After setting up their test markets, word is that plans to expand the POWER program have been put on hold until 2011. I used to work for the Pharmacy America Trusts When They Are Too Lazy To Get Out Of Their Car To Pick Up A Prescription, and one thing I took away from the experience was the impression of competence from the top-level, strategic planners at the organization. I'm not kidding you. If Walgreen's can't make this work, than there's no way the company you work for can, and right now there's some doubt as to whether Walgreen's can make this work.

For the sake of the public and the profession, I hope they don't.

Click here and here to read some of the internet forums regarding the POWER program.

Click here and here to read The Angriest Pharmacist's post on the subject.

34 comments:

Anonymous said...

CVS is also playing with the idea of central call centers... I guess it's in early stages. Last I heard (about a year ago) the central pharmacists couldn't even pull up the hard copy of a script to look at it. Also, the patients can demand to speak to their regular pharmacists and the call is forwarded to them. Can you imagine the first 3 minutes of that conversation? Man as if we don't get yelled at enough for crap out of our control.

Anonymous said...

I'm an RPh for Walg in Wisconsin, and POWER will never happen here due to a state law outlawing central fill pharmacies. *loves that state law* Don't get me wrong - I wouldn't mind having some of my daily duties done "off-site," but I can just imagine how patients would react to that around here. We have a lot of older patients at my pharmacy who will walk in with their 2 or 3 refills and just wait. Although, apparently, that's what's happening in Florida and Arizona - patients are realizing that if they walk in with their bottles, they can pick them up the same day ... so pharmacies with LESS staff are getting slammed with MORE people waiting on RXs.

Anonymous said...

so next they can outsource our jobs to India too??

just great.

Anonymous said...

Just imagine what the AMA would do. Why is the profession of pharmacy so weak and neutered??
I just filled a $1218 bottle of seroquel, and I was reimbursed $1220...2 freakin dollars!! so of course chains are finding ways to cut costs ( biggest of which is pharmacists)-

The problem lies with the dirt poor reimbursements from the PBMs. Perhaps if we fix that we can be treated like professionals again.

So have any of you called your reps to have them support the Pharmacy Bill currently in committee??

If not, then you deserve whats coming.

RXJOE said...

I said it before and I'll say it again.. be very careful of this program, sooner or later they will get it right, and it's worse than you think.. after they've figured out how to re-route the work off-site, the phone calls, DUR checks and any other tasks that can be done off-site will eventually be done OVERSEAS where it's even CHEAPER to run call centers and to have pharmacists doing DUR's from home or even at the same call center.. this is only the beginning and it doesn't look good!

Anonymous said...

I am a WAG rph in NC and i just don't see this happening in my rural area! For one thing, the marjority of my patients are sit and wait for my rx, or 15 min is way too long patients (remind me why we call them PATIENTS?). My DM assures us it will be quite some time before we see POWER in NC. I have called a WAG in FL and was routed through POWER and OMG was it awful! If a pharmacist cannot get through to a live person easily I know the majority of patients will not!

Anonymous said...

They are already doing this at the store I work at in NY. When you call the stores number you aren't talking to anyone at the actual store. The call center often transfers the problems to us...though never the easy ones.

Our store also uses a central fill pharmacy and we receive at least 150 scripts a day that have been filled there. The higher ups are big on pushing tomorrow pick ups so things are cheaper to fill.

I suppose its worth it at stores where you do a high volume. Though we are slowly being replaced by robots and technology...such is life. :o)

The Alert Reader said...

If you work for walgreens, you've already gotten a taste of this system. When you scan a prescription and don't open the image immediately afterwards to enter it into the system, a tech/pharmacist in another store in your district can open it up and enter it for you. 99% of the time with this one local doctor, it gets entered incorrectly. Other pharmacists/techs in the district are not as familiar with the prescribing habits (and penmanship) of local doctors, and it ends up slowing everything down. After our pharmacist DRE's it, another tech has to fix the number of refills (His 3 looks like a 1 but it is ALWAYS a 3) or quantity (not a 10, that's a 30), etc. and then FINALLY we can start getting it ready for the patient.

Sigh. He writes like 80% of the prescriptions we fill at our store. On a slow day, when someone else enters the Rx into the system, it ends up taking longer to process than if we do it on our own.

Niffer said...

I call at least fifty pharmacies a day, and calling these fucking pharmacies are the worst part of my days. The FL ones are the absolute worst. I get transferred to up to six people before I can be helped...the only thing that is improved is how quickly the phone is answered.

Phathead said...

Why do I get the feeling we are a few years away from Walgreen's genetically engineering monkeys to perform tasks like this.

Seriously, it can't be that far away.

Anonymous said...

I also work for WAG in WI and I talked to a higher up at a hiring fair and he was talking to me about power. He made it sound awesome of course, but what I've heard from FL and AZ is that they cut way back on pharmacists and staff. Not so good.

Anonymous said...

We should all be very frightened by this program not only because WAG is using it but because as soon as they perfect it everyone one else, i.e. RAD, WMT, CVS, etc., will follow. Pharmacy is a business, it exists to make money and nothing else. If you believe differently you are wrong. We are simply a relic from a by-gone era, neccessary only because the law says so. As soon as someone (WAG) figures out how to circumvent the law, or use central fills on a grand scale, we are finished. The others will simply fall in line.

ThatDeborahGirl said...

How else is Walgreen's supposed to pay for all those spanking new buildings that they're putting on prominent cornerspaces that couldn't have been cheep to get.

In the case of my neighborhood, they're going from a larger building to a smaller building - all for the sake of having a brand new Walgreens on a corner instead of the middle of the street. I even had an employee tell me that it's because they're taking quite literally the "on every corner" advertising bs and trying ot live up to it.

The people who are mainly getting screwed on space is the pharmacy because it's ridiculously smaller than the building they're in now - you can see that even now while it's not even completed & because of this blog, I think about things like that now.

And I thought...hmmm...less space = less stock & less people.

And then I read this and I get it. It's crazy but by the time people find out about stuff like this, just think how long it's already been it the works, even to planning smaller pharmacy spaces in their sparkling new corner stores.

I'd stop shopping there but where the hell else would I go? CVS, Wal-Mart or Kroger? Which should I pick?

Từ Thanh Giác said...

Costco is also doing it.

Kate said...

Y'know what...I say bring it on. When people start dying and the lawsuits start piling up due to medication errors, they'll just have to learn the hard way. It may seem like a good idea financially now, but so did Premarin when it seemed like it prevented heart attacks and Alzheimer's.

I'm lucky enough to work for an independent, and what strikes me about my work is how much waste, fraud, abuse, and injury I prevent *simply by being in the same pharmacy every day*. It's not like I go home and memorize patient histories...you just pick up so much as a pharmacist by repetition, and having been there the day before for that phone call, that interaction...whatever. Every time we have a temp RPh or a new intern, I have to clean up some kind of mess...not because they're incompetent, but because they just haven't been there.

How is some pharmacist miles away, even with a giant genius brain and all the best interaction software in the world, going to be able to pick up on the day-to-daystuff? Answer: they can't. It's impossible.

So yeah, APhA and all the state pharmacy orgs need to get hip...and the AMA too. I talk to docs who know and trust and depend on me everyday. They aren't gonna like being directed to some random pharmacist at a call center.

Anonymous said...

We have already been told that "wag isn't tracking error rates on scripts checked remotely"...why?? Because they just don't give a fuck...There new motto should be "just do it" because they realllly hate when they are questioned about new policies.

"There's a way" WTF does that mean anyway???

Anonymous said...

I liken the system to the beginnings of Marxism. It all sounded great - everybody's equal, everybody's doing the same amount of work. Yeah, not so much. Look, WAG wants us to believe that every pharmacist has the same talents and abilities. Well, they don't. Most of them are quasi-retarded and I can't believe a state put the faith in them to be registered. I abhor having some douche at a slow store "checking" the work I then have to fix. Too many cooks spoil the pot. Speedy Marxism is not the rx for bigger profits (not always), but it will cause the stock to jump. Ahem. It's climbed nearly double in the last year or so....maybe with a couple more facilities...maybe it'll split and the shareholders will rejoyce. Hooray Marxism! How did that end the first time again?

The little tech that does... said...

I work for a chain that is retail, but not grocery (nor is it Walmart or Kmart). Due to recent changes in the Walgreens filling process, we have picked up several new patients. Apparently not only talking to someone that is in a different location, but the processing errors and wait times have driven them away. Proximity doesn't always convey convenience.

Anonymous said...

It's all starting to fall in place, now. Here's more crazy talk. Wednesday on NPR there was talk about opening up the drug market to overseas (pushing the FDA beyond what little control they can help with alread). Then, there's wild talk about $1.55/Rx reimbursement for Medicare. There's no government option on the boards, so the insurance industry (and pharmaceutical industry in cahoots) can keep going right ahead telling pharmacists when they can go to the bathroom. Looks like we're poised, at the precipice...

Anonymous said...

Maybe when they roll out this monstrosity, they can fix vision and workload balancing so that when an offsite store types my script, they can actually fucking enter the medicaid tamper proof script override. IT'S A NATIONAL REQUIREMENT. HOW DID THEY MISS IT?

Do you have any IDEA how irritating it is to press two buttons and tell a patient who has come back three hours later, "I'm sorry this isn't done yet, there's an override that has to be entered before we can start filling it. It's going to be a few minutes."

Besides keeping my job, my biggest fear with POWER is that instead of being able to apologize for my mistakes, I have to apologize for some cubicle monkey instead. That doesn't piss people off any, not at all.

woolywoman said...

Kaiser does this, but only within a local region- ie Northern CA, Southern CA. They will also mail the script to your house, for free, and a lot of people like this. But in the rest of the world, I don't think it makes sense, not that that has ever stopped them....

Phurious said...

I just wanted to say how much I hate this fucking job. Thank you and good night. Where's my cubicle?

Anonymous said...

What is really maddening is that APHA, ect. have not said one dang thing about POWER. Every pharmacist I have ever talked to about POWER agrees it increases error rates. Not one peep from APHA.

Anonymous said...

I just wish the public would read this http://www.ismp.org/Newsletters/acutecare/articles/20091203.asp and then back off asking why their prescriptions take so long to fill and if it's a free antibiotic or on the $4 list... Daryl_RPH_in_OH

Anonymous said...

I work at an independent pharmacy in Arizona, and POWER is the most annoying thing I've encountered thus far in pharmacy. Sure, before POWER you had to sit on hold for 30 minutes to talk to a pharmacist at Walgreens. Now you have to talk to 5 people just to get to a "pharmacist" in Florida, when you really need the ACTUAL PHARMACIST of the Walgreens around the corner to see if they have Vfend on their shelf. And transfers? Don't even get me started.

Anonymous said...

I work at POWER....anyone have any questions for me?

Anonymous said...

I made the mistake of going to work for Walgreens a year ago. The entire experience has been pathetic.....I can't imagine continuing to work for this miserable company if on top of it all I became a Power RPh/cashier. I feel like I should add "Bagger" to my resume as it is.

Anonymous said...

I work for POWER...its a horribly unorganized system and just from some trends I see I know the error rate for filling prescriptions has to be extremely high.

Anonymous said...

I work for WAG in full POWER. What do I do in a POWER store? I run the register, ring up condoms, diapers, wee-wee pads, tank-tops, bras, anything and everything WAG sells and also the prescriptions of course. Lovely isn't it? After my 6 year Pharm.D. education, this is what I've been reduced to. I also get both lanes of drive-thru, with one tech who is fanning herself filling, taking her time, while I run back and forth. I'm also forced to check the rx's in front of patients (not allowed to open the vial, just roll the bottle around and not allowed to recheck the hard copy either) and get VM's when the line is down. I'm required by BAFT to get the VM at the consultation window, so when I do get the VM, the patient will walk up and read what I'm writing to be nosy. HIPPA violation? Not according to WAG! I go 8 hours without lunch. There are often times I feel so lightheaded from low glucose levels, I feel sick but I can't sit because I have to get the neverending line. Then halfway through the tech's shift, she goes to lunch and leaves me alone to run the register, drive-thru, filling, and any TPR's that the resolution center does not resolve. I try to counsel the patients, and most don't want to hear it, don't give a sh** about what I say, or say "yeah, yeah, give my rx so I can go" When they see me ringing stuff up, they don't even want to ask my any questions anymore. Go POWER!!!

Anonymous said...

Well I can tell you I have a much different perspective than all of you and I work in the Care Center in Tucson, Arizona.
First off most of these pharmacies in Arizona take in around 300-400 scripts per day, many of them simple re-fills. The reality is most of these calls are around 90 seconds in length, however a 1/4 of them take friggin forever to give you one RX and do you really want to wait in line at the store while some technician has to take the call or create a situation where it can be handled by another certified tech while the story customers gets handled. Any by the way idiots I am an American citizen not some guy from India, either way a technician is going to take the order, better to have one in a call center USING the same friggin system to handle the difficult customers. I dont know what store some of these people are working in that the customer loves to wait but in reality, they want it yesterday, complain about the wait time no matter what, and will spend another 10 minutes confirming there order. Yeah OK I want to wait in the store while Miss Daisy confirms her suppository RX while I have a huge gash in my head and need Oxy's. Second half the customers are calling back because there doctor called in like 2 minutes OK and they want to confirm that you got the fax and dont care how busy you are. Its people like me that keep those people from calling up your ass trying to re-fill Class II's while you help truly need customers.
Bottom line is the call center has qualified reps many of who take alot of grief from these so called pleasant customers. The ones I get lie, deceive, and attempt to intimidate to get meds and often have an attitude regardless of how well you treat them because somehow they feel wronged. They feel upset that were not calling the doctor every 3 seconds to bug them for refills or its somehow our fault the doctor never called in their meds. And you know what the pharmacists, and the customers treat the call center like crap. They say we are so bad and often clean up many mistakes.
I have been to the pharmacies and I can tell you there often is not room for another 5 people ther taking calls and yet you get so many calls you cant even pick up the phone. Walgreens has more complaints of either the store not picking up the phone, or hanging up on customers. A sure sign I am correct that the store could never handle the volume of calls if WE werent there.

Anonymous said...

I am an ex-WAG pharmacy manager just checking in to see how POWER is going. My store lost a pharmacist, and my tech hours were cut so low that I had less than one tech per hour of operation. FL BOP fought for a 3:1 tech:RP ratio, and I had a less than 1:1. Basically, the tech fills and checks the scripts, and the pharmacist sells the scripts AS A CASHIER WHO WORKS THE DRIVE-THRU AND CASH REGISTERS. No matter what you read, I can tell you that WALGREENS PHARMACISTS DO NOT CHECK THE PRESCRIPTIONS. I can also tell you that the central pharmacy's quality of work is poor overall. I used to be able to fill a Z-Pak for a sick patient in the drive thru while they waited--30 seconds to type the rx while gathering their info--label printed while they handed me their credit card--came back with rx and rct. With POWER the same process takes at least 15 minutes and 2 visits to the drive thru. I told WAG how much POWER sucked and they said to me (a successful manager) "we either need you on board with this or we don't need you." So I quit. Someone else will have to give flu shots to people while working ALONE with a line in the drive thru. I moved on to a job that sucks less.

$135,000CASHIER said...

First I feel sorry for the customers that come to WAG (as a company) to get thier prescriptions filled. I'm sure there are great WAG pharmacies, but there are a huge number of CRAPPY WAG pharmacies. Unfortunately the general public see and come to WAG because of the PAST HISTORY and NAME that WAG has built. FYI the WAGREENS name is worth over 2 Billion Dollars in itself!!! However WAG is not that same great pharmacy as before..THE PHARMACY AMERICA TRUSTS.. That's long gone. There is NO TRUST left with WAG. WAG is like your corner gas station to the general public. We are on the corner and it is convient. They sell gas and we sell drugs. We are both in business to turn a profit(and it better be more than the previous year) at any expense. It just sucks that WAG has taken the LOW road in COMPRIMISING CUSTOMER SERVICE ALL BECAUSE OF CORPERATE GREED.
I am also sorry for the abundance of great pharmacy technicians that will be forced out to run the front register or be handed thier pink slips.

Another WI RPh said...

Anonymous said...
I'm an RPh for Walg in Wisconsin, and POWER will never happen here due to a state law outlawing central fill pharmacies. *loves that state law*
-----------
Anonymous needs to look at WI Phar 7.12 and get up to speed for when it happens in WI. http://legis.wisconsin.gov/rsb/code/phar/phar007.pdf

Anonymous said...

The Angriest Pharmacist's post has been deleted, so I cna't see the original post .... guess he couldn't handle the heat.